Context matters : women's experiences of depression and of seeking professional help : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Albany, New Zealand

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(2) CONTEXT MATTERS: WOMEN'S EXPERIENCES OF DEPRESSION AND OF SEEKING PROFESSIONAL HELP.. A thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Albany, New Zealand.. Jodie Anne Batten. 2012.

(3) ii. Abstract Most existing research on women and depression takes a realist approach that effectively silences the voices of women and limits our understandings of depression. By engaging with the stories of seven women, recruited from a provincial New Zealand area, this research privileges women's voices. Taking a discourse analytic approach, this research explores how women construct their experiences of depression and of seeking professional help. I take a micro discursive approach in identifying how the women utilise various discursive resources in constructing their accounts of both depression and of seeking professional help. In order to locate these discursive resources within the broader socio-cultural environment, I employ a macro discursive approach drawing on Foucauldian discourse analysis and Davies and Harré’s Positioning Theory. Participant’s accounts of their depressive experiences change over the course of their journeys. I explore how the women's accounts shift from a contextualised explanatory framework that locates their experiences of depression within the gendered context of their lives, to a medicalised explanatory framework as they enter the professional help arena. This research offers insights into how dominant discursive construction of the ‘good’ woman/mother dovetail with a biomedical explanation of depression and prevailing discursive constructions around anti-depressant medications. Working together, these discourses effectively silence women's voices, both pathologising and decontextualising women's depressive experiences. Furthermore, I suggest that these dominant discursive resources and practices offer limited ways for women to make sense of their experiences in meaningful and empowering ways. A need for new understandings about women and depression is called for one grounded in the material-discursive realities of women’s gendered lives..

(4) iii. Acknowledgements First and foremost, I want to thank the women that gave their time and knowledge to assist me in this research. Of course, I could not have done this without you - my heartfelt, humble thanks for sharing your stories with me. I hope that I have managed to represent your stories and achieved what you hoped.. To Professor Kerry Chamberlain – thank you so much for your time, wisdom, support, and encouragement. Thanks for Monday morning phone calls to keep me on track and remind me there was someone else out there. For a long distance student your support has been invaluable.. Thank you to the North Shore Women's Graduate Institute for your financial support and for you encouragement. It was invaluable and inspiring.. To Dr. Tresna Hunt – what can I say – thanks for being my ear, and my friend. You make it all so much easier. Thank you to my amazing family – to Jason, who made it possible on so many levels for me to do this work and complete my degree. To my beautiful daughters, Isla and Keira - you are amazing and I love that you have been supportive even when you really wanted me to stop writing and play. And, thank you to my parents for having faith and being there when I needed you..

(5) iv. Table of Contents ABSTRACT ................................................................................................................................................II ACKNOWLEDGEMENTS ............................................................................................................................... III TABLE OF CONTENTS ..................................................................................................................................IV CHAPTER ONE: INTRODUCTION........................................................................................................... 1 WHY FOCUS ON WOMEN? ......................................................................................................................... 2 THE RISE OF THE BIOMEDICAL MODEL OF DEPRESSION ...................................................................................... 3 AN ALTERNATIVE VIEW .............................................................................................................................. 5 LOCATING THE CURRENT STUDY ................................................................................................................... 8 THE RESEARCH FOCUS .............................................................................................................................. 11 CHAPTER 2: METHOD........................................................................................................................ 12 DISCOURSE AND SUBJECTIVITY ................................................................................................................... 12 RECRUITMENT ........................................................................................................................................ 12 PARTICIPANTS ........................................................................................................................................ 13 INTERVIEWS ........................................................................................................................................... 14 ETHICAL CONSIDERATIONS ........................................................................................................................ 15 ANALYTIC PROCESS .................................................................................................................................. 16 PRESENTATION OF THE FINDINGS ................................................................................................................ 18 CHAPTER 3: FINDINGS AND DISCUSSION ........................................................................................... 19 BECOMING DEPRESSED............................................................................................................................. 19 A gendered phenomenon. .............................................................................................................. 22.

(6) v. A feedback loop. ............................................................................................................................ 26 Wearing the mask.......................................................................................................................... 26 CHAPTER 4: FINDINGS AND DISCUSSION ........................................................................................... 29 ENTERING THE PROFESSIONAL HELP ARENA .................................................................................................. 29 Professional help ‐ receiving a diagnosis. ....................................................................................... 30 Medicalised understandings. ......................................................................................................... 33 Taking up a diagnosis of depression............................................................................................... 35 I have a diagnosis. ......................................................................................................................... 39 A new way of talking. .................................................................................................................... 41 CHAPTER 5: FINDINGS AND DISCUSSION ........................................................................................... 44 THE AFTERMATH..................................................................................................................................... 44 Section 1: Medicated living. ........................................................................................................... 46 Not just a prescription: the performance of prescribing ................................................................................47 A safe and effective option ...........................................................................................................................49 Constructions of side effects ....................................................................................................................51 Efficacy talk ............................................................................................................................................53 Problems with withdrawal .......................................................................................................................54. Section 2: Living with complexity: Continuing invisibilities. ............................................................ 56 Difficult decisions ..........................................................................................................................................58 Cautious attempts, the problem with language ...........................................................................................60 The trouble with symptoms ..........................................................................................................................62 Sadness entitlements. ...................................................................................................................................65.

(7) vi. Points of resistance and power dynamics.....................................................................................................66 Circular logic .................................................................................................................................................68 A lack of alternative discursive resources .....................................................................................................69 Remaining vigilant ........................................................................................................................................70. CHAPTER 6: CONCLUSIONS ............................................................................................................... 72 REFERENCES ..................................................................................................................................... 76 APPENDICES ..................................................................................................................................... 85 APENDIX 1: INFORMATION SHEET ............................................................................................................... 85 APPENDIX 2 CONSENT FORM. .................................................................................................................... 88.

(8) 1. Chapter One: Introduction “...depression is the major scourge of humankind” (Kramer, 2005: 153) The aim of this research is to explore women's experiences of depression and seeking professional help. When I first made the decision to explore these aspects of depression, people asked, “Why would you look at depression, surely that topic has been done to death?” There is certainly truth in the idea that depression is a topic that has been extensively theorized and researched, and yet, in spite of this significant body of research, there exists no clear consensus about the etiological underpinnings of depression, or the suitability and efficacy of various treatment models. There is continued debate regarding how best to address depression at an individual and societal level. Depression quite clearly is a highly contested disorder. The World Health Organisation (WHO) Global Burden of Disease (GBD), 2004 update cites unipolar depression as one of the foremost contributors to disease burden around the world (Mathers, Fat, Organization, & Boerma, 2008). In 2004, unipolar depression was cited as the third leading cause of disease burden worldwide and had the dubious honour of being ranked first in middle-to high-income countries. New Zealand statistics for overall burden of disease from unipolar depression are consistent with international prevalence rates with NZ ranking second in a study of ten high-income countries (Bromet et al., 2011). WHO predicts that by the year 2030, unipolar depression will be the leading cause of disability worldwide. A further finding from the GBD epidemiological studies that has generated significant concern centres on the gap between the numbers of people experiencing depressive disorders and those receiving treatment. It is estimated that depressive disorders affect 121 million people worldwide with only a small minority of these people seeking or receiving even the most basic care (WHO, 2001). This gap, termed the “treatment gap”, is a primary focus for newly prioritised intervention efforts aimed at addressing the ‘epidemic’ of depression currently facing individuals and societies worldwide. In the face of such alarming statistics, it would appear, despite the already extensive amount of research on depression revealed by any search of scientific publications, depression is indeed a topic that warrants our attention..

(9) 2. Why Focus on Women? Epidemiological researchers consistently cite women as over-represented in worldwide depression statistics. WHO cites depression as the leading cause of disease burden for women aged 15-44 worldwide (Mathers, et al., 2008). Furthermore, estimates of lifetime prevalence for depression consistently indicate that women outnumber men at a ratio of 2:1 (Bromet et al., 2011) although others have put this figure higher suggesting ratios of up to 4:1 (Ussher, 2010). Available data for prevalence rates of depression for New Zealand women indicate that these gendered patterns are similarly applicable (Wells, Oakley Browne, Scott, McGee, Baxter, and Kokaua, 2006). While WHO (2001) epidemiological studies highlight the existence of a ‘treatment gap’, of those people who do seek treatment, the majority of these will be women. While the processes involved in help-seeking behaviours are poorly understood (Schomerus & Angermeyer, 2008), it is widely accepted that women are more likely to seek help for emotional distress, more likely to receive a diagnosis of depression, and more likely to be treated with anti-depressant medication (Currie, 2005; LaFrance, 2009; Stoppard, 2000; Ussher, 2010). Estimates suggest that women receive two out of every three psychotropic medication prescriptions (Horwitz & Wakefield, 2007). Although New Zealand data is somewhat limited on the use of antidepressant medication, a 2011 article in a popular monthly magazine North and South suggested that anti-depressant medication prescribing rates are at record levels with 1.2 million prescriptions issued in 2010 alone. Women are estimated to take anti-depressant medications at twice the rate of men and in some New Zealand areas almost 1 in 7 people are using antidepressant medications. According to these statistics, a significant number of women are being diagnosed with depression and treated with medications. This modern phenomenon depression as a mental illness with a biochemical base - is one that has become highly medicalised, not to mention pharmaceuticalised, and popularised. The World Health Organisation predicts a significant rise in the prevalence of depression by 2030. If current gendered rates continue unabated, and there is little reason to assume otherwise, women will continue to figure disproportionately in these figures. That is, to put it simply, a lot of women who are likely to experience depression and be treated with antidepressant medication over the next two decades. There is clearly widespread agreement that depression is a condition that affects women worldwide in alarming numbers. Yet despite WHO’s statement that, “mental disorders can now be diagnosed as reliably and accurately as most of the physical disorders” (WHO, 2001, p.22) as Janet Stoppard (2000) points out, it appears that what we know about women and depression is remarkably little..

(10) 3. This raises an obvious question - what is missing from current understandings on depression and women? Perhaps the answer lies in the focus of research and the nature of our enquiries.. The Rise of the Biomedical Model of Depression Mainstream research into depression has taken a predominantly realist or positivist approach. From within this framework it is assumed that facts about the world can be empirically ascertained through observation and rational deduction – that we can attain objective knowledge (Yardley, (1997) and that this will be untainted by the values, judgements or perceptions of the observer or researcher. Furthermore, this framework assumes it is not only possible, but also desirable to obtain or discover these ‘facts’ independent of the socio-cultural context. From this realist position, subjective phenomena are confounding variables that detract from the true nature of the entity in question. From within this framework research on depression seeks to identify and establish causal pathways and begins with assumptions of the ‘bounded individual’ – best understood separately from the socio-cultural context. Mechanisms involved in the production of distress are best studied in isolation and researched at their most simple level with a view to generalising to a more complex system. Research conducted from this position has attempted to explain the casual pathways involved in the production of depression as arising from biological dysfunction, primarily in neurotransmitter functioning and genetic vulnerability (Currie, 2005; Rose, 2007). While psychosocial factors have not been ruled out of consideration in the development of depressive disorders, as Rose (2007) points out, it is through their action on the neurochemical brain that they are now understood to have their impact (p. 220). Furthermore, in line with this focus on biological systems, it is concluded that women's greater propensity to depression lies somewhere in women's biology and/or particular cognitive, personality or interpersonal style (Hirshbein, 2006). For research purposes, gender is treated as a characteristic of the individual - either male or female. Treatment is targeted at the level of the individual, either through the use of psychotropic medication or a combination of medication and therapy, most commonly, cognitive behavioural therapy (CBT) (Stoppard, 2000; WHO, 2001). Feminist and postmodern scholars highlight several problematic assumptions within mainstream theorising and research on depression in psychology (Caplan & Cosgrove, 2004; LaFrance, 2009; Stoppard, 2000; Ussher, 2010; Yardley, 1997). While depression, particularly depression in women, has been conceptualised in various ways, a common thread in these mainstream.

(11) 4. formulations is the ongoing focus on the individual as the site of pathology. Thus, while offering potential for a broader theoretical framework for understanding depression, psychosocial formulations are criticised for the continued conceptualisation of ‘depression’ as a discrete and real entity, one that exists independent of language, culture and perception and is located within an individual sufferer (Marecek, 2006; Metzl & Angel, 2004; Pilgrim & Bentall, 1999; Stoppard, 2000; Ussher, 2010; Yardley, 1996). In addition to this medicalised conceptualisation of depression with its focus on the individual, social constructionist scholars also highlight problems inherent in such models for their conceptualisation of the biological, social, and psychological domains as distinct and separate from each other (LaFrance, 2009; Stoppard, 2000; Ussher, 2010; Yardley, 1996). Existing integrative biopsychosocial and diathesis-stress models for understanding depression and informing treatment strategies are rooted in epistemological assumptions that ‘reify’ limiting dichotomies of body/mind, objectivity/subjectivity, and individual/society (LaFrance, 2009; Yardley, 1997) with the former of each privileged over the latter. These dichotomous conditions not only support they are expressed in the narrow conceptualisation of gender, subjectivity, and the social context in research and thus ultimately in treatment (Cosgrove, 2000; Galasinski, 2008; LaFrance, 2009; Maracek, 2006; Stoppard, 2000). In research based on positivist epistemology, the uncritical acceptance of sex as a subject variable, a dichotomous and stable trait, effectively works to exclude phenomena such as the gendered division of labour and symbolic aspects of gender from theorizing about depression (Stoppard, 2000). In addition, the aim of prediction and causal explanation inherent in these models is said to result in oversimplified, partial understandings (Maracek, 2006). Attempts to assert the dominance of one domain over another in explanations and treatment of depression fails to recognise the continuous and multi-layered reciprocity between all domains of experience (Yardley, 1996). Yet, despite these concerns, the biomedical model of depression has gained an increasingly high profile in public discourse over the last three decades and currently dominates public discourse (Clarke & Gawley, 2009; Galasinski, 2008; Gardner, 2003; LaFrance, 2009; Lewis, 2006; Rose, 2007). The inclusion of diagnostic criteria for depression in the American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders DSM-111 (1980) and the biomedical proclivities it rested upon was a pivotal point in the shift toward the construction of depression as a naturally occurring and discrete entity. This new conceptualisation firmly shifted research on depression into a scientific framework whose fundamental premises about the world shaped the type of research that would follow. A biomedical model of depression posits that depression is caused by a chemical imbalance in the brain, and most commonly cites.

(12) 5. decreased levels of the neurotransmitter serotonin as the primary problem. From this viewpoint, depression is a mental illness with a biological base best treated with anti-depressant medication. This is clearly reflected in WHO (2001) guidelines that highlight the importance of making psychotropic drugs available to all, and states medication is the first line of treatment when dealing with depressive disorders, either alone, or in combination with evidence-based psychological therapy (WHO, 2001).. An Alternative View Any reading of popular media coverage of depression, or a search of mainstream academic and scientific publications certainly suggests the dominance of the biomedical model of depression is a ‘fait accompli’ – a product of accumulated and ever-sophisticated scientific advances in medicine. Despite this apparent consensus, an alternative is viewpoint offered by social constructionist writers. From this viewpoint, all knowledge prevailing in a culture at a particular point in time is constantly negotiated through social interaction – language, or discourse being the primary source of its construction (Burr, 2003). Knowledge production is therefore always culturally and historically contingent (Burr, 2003; Kirmayer, 2006) and is intimately bound up with power – the power of any regime to promote its particular version of reality (Foucault, 1973). Thus, from this viewpoint, the biomedical model of depression in Western society dominates not because of advances in medicine, but because of the economic, political, and institutional power of science and medicine to construct its particular version of reality (Burr, 2003). Terms such as depression, mental illness, abnormality, and normality do not bear any correspondence to ‘real’ or discrete entities – rather they are social constructs, invariably dependent on the values and judgement of those doing the defining (Caplan & Cosgrove, 2004). The elevation of such constructs to a supposed ‘truth’ or common-sense status is dependent on a group’s social and political or economic power to promote and maintain this version of events. Furthermore, any particular view or knowledge of events brings with it the possibility of social practices – enabling certain ways of acting while at the same time marginalising others (Burr, 2003) - thus, Foucault’s (1973) claim that discourse, knowledge, and power are intimately connected. From this position, the currently prevailing constructions of depression, particularly constructions of women who are depressed, are viewed as problematic, functioning as an effective means of pathologising and decontextualising women's experiences of intense sadness. The concerns/critiques of the biomedical model of depression are twofold. The first set of.

(13) 6. concerns focuses on the assumptions and inherent biases involved in the development of the current diagnostic classification system for identifying depressive disorders – the American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders (DSM). While not all scholars decry the use and potential benefits of such classification systems, this viewpoint does call for a critical stance, and emphasises the need to examine the underlying assumptions and power structures embedded within such systems. Taking a variety of starting points, these critiques include examinations of the particular power structures that serve to promote and maintain this version of reality. Some of these critiques emphasise the need for an historical perspective, highlighting the political and scientific context that surrounded the development of the DSM-111 (Greenberg, 2010; Kirk & Kutchins, 1992) and the resultant adoption of a scientific rhetoric and a philosophy of empiricism. Other scholars, while clearly identifying power structures, focus more specifically on the ‘bad’ science involved in the decision to move away from etiological considerations in identifying depressive disorders to symptom-based definitional criteria utilised in the DSM-111. This decontextualised approach is posited to have effectively removed the distinction between endogenous versus reactive depression, and as Horwitz and Wakefield (2007) state, collapsed the distinction between sadness/grief and Major Depressive Disorder (MDD). Others highlight the interplay between the development of a specific diagnostic category of depression – DSM-111 - and the introduction of medications in psychiatry in the 1950’s and 1960’s (Healy, 1997; Rose, 2007). A particular focus of such critiques is the circular reasoning involved in the development of specific diagnostic criteria for depression based on responses to medications that appeared to help individuals thought to be depressed – these individuals then being diagnosed with depression (Gardner, 2003) . This circular reasoning, alongside the political and scientific context that fuelled a perceived need to move psychiatry onto a scientific footing, opened the way to a new approach to theorizing about depression - as a distinct disorder with a biological base. Other critiques highlight the cultural and gender biases involved in these processes (Hirshbein, 2006; Kirmayer, 2005). Kirmayer critiques the overriding assumptions underlying mainstream theorising on depression – depression as a trans-historical and trans-cultural phenomenon. Hirshbein points to the often hidden gendered assumptions in depression research. She points to the predominance of women in the studies that aimed to develop symptom-based criteria for depression to be included in the DSM-111. Furthermore, she highlights the predominance of women in clinical trials of medications for depression around the same time. Assumptions about women's greater propensity to depression, and assumptions about women's biology as the likely cause, she posits, arose directly out of an uncritical acceptance of these studies on women.

(14) 7. as being studies on depression itself. Such assumptions have led to an intertwining of the biology of depression and women's biology that dominates depression research today (Hirshbein, 2006). A significant number of scholars have explored the relationship between pharmaceutical companies and the promotion of depression as a biomedical illness in scientific and popular media (Clarke & Gawley, 2009). Many of these highlight the role of pharmaceutical companies in expanding medication markets through processes that some have termed ‘disease mongering’ (Currie, 2005; Double, 2002; Medawar and Hardon, 2004; Moynihan and Henry, 2002). Several scholars have explored the promotion of depression as a biochemical illness through a variety of channels including direct-to-consumer advertising (Currie, 2005) and government depression literature (Gattuso, Fullagar, & Young, 2005). Many critiques specifically highlight the discursive construction of women's unhappiness as depression. Metzl and Angel (2004) explore how Selective Serotonin Reuptake Inhibitors (SSRI) anti-depressants have played a contributing role in expanding categories of women's mental illness in relation to categories of ‘normal’ behaviour. They concluded there had been a clear shift to positioning women's normal reactions to life events such as marriage, motherhood, menstruation, and menopause as depressive illness treatable with anti-depressant medications. Other scholars have explored discursive constructions of women's unhappiness as depressive illness in popular women's magazines (Gattuso et al., 2005) and in a range of mass-circulated literature (Blum & Stracuzzi, 2004). Through a variety of mediums, particularly SSRI advertisements, emotional experiences such as sadness, crying and never feeling happy, are increasingly positioned as depressive illness (Ussher, 2010). These critiques highlight the complexity of the relationship between the development of the DSM-111, pharmaceutical companies, and the development of a biochemical model of depression. Such critiques are critically important for women who experience depression. The current DSM classification system is the basis for the majority of research conducted to date on depression and women (Caplan & Cosgrove, 2004; Hirshbein, 2006; Mirowsky & Ross, 1989). As Horwtiz and Wakefield (2007) state, “The fact that these symptom-based definitions are the foundation of the entire mental health research and treatment enterprise makes their validity critically important” (p7). The second, and related set of concerns, primarily focus on the implications for women when depression is conceptualised in this way. The story about women and depression, told through the biomedical model, has real and profound implications for women experiencing depressive symptoms. The way depression is constructed - in this case as a disorder residing in the.

(15) 8. individual - whether it is from psychological or biochemical dysfunction - positions the individual in certain ways, has implications for the actions that should be taken, and is implicitly bound up with the construction and negotiation of subjectivity. As Burr (2003) points out, individuals draw on discourses circulating in society to construct different versions of reality. As individuals, we can draw on different discourses at the same time, and thus we can speak ourselves into different ways of being. However, this is only possible within the parameters of the discursive resources, or sets of meanings available within a given cultural context (Burr, 2003, Parker, 1992). Additionally, as Willig (1999) says, “discourses contain a range of subject positions which in turn facilitate and/or constrain certain experiences or practices” (p. 43). Therefore, it is possible for individuals to position themselves within discourse and also for individuals to be positioned by discourse (Davies & Harré, 1990) The discourses available to an individual therefore shape the ways in which they can understand and experience the world (Willig, 2000). To this end, much of the research within a discursive framework has focused on the medicalisation of sadness and the positioning of women as mentally or medically ill (Riessman, 1992; Ussher, 2010). It is from within this discursive framework that a growing body of literature offers new ways of looking at women's depressive experiences. One that challenges these essentialist notions of the individual and of gender; one that sees women's depressive experiences as embedded within the landscape of women's lives; and one that recognises the social, discursive, and symbolic aspects of experience as critical in understanding how women experience and understand depression. It is from within this broad framework that the current study is positioned.. Locating the Current Study This study examines the personal stories of women who have experienced depression and made the decision to seek professional help. The importance of grounding this study in the women's personal stories – to hear their voices – to acknowledge the value of their stories for offering alternative ways of understanding depression – became increasingly apparent as I explored the available literature. As Stoppard and McMullen (2003) suggests, knowledge about depression is ultimately held by those who experience it and yet, the voices of those who experience depression are effectively silenced by existing models (Karp, 1996). Studies that have explored the personal accounts of individuals who experience depression have consistently highlighted the importance of context in understanding how people make sense of their depressive experiences. Using a variety of qualitative approaches, research that focuses on.

(16) 9. women's verbal accounts consistently finds that when women are asked to talk about their experiences of depression they do so by talking about the conditions of their lives (Stoppard & McMullen, 2003). Working within a feminist framework, scholars such as Jack (1991) and Mauthner (1998, 2002) have explored women's experiences of depression. Their work has been instrumental in highlighting central themes about women’s nature and women's lives embedded within culturally located discursive resources, as critical in shaping women's subjective experiences of depression (Stoppard, 2000). Jack’s (1991) study explores women's depression as rooted in the relational self, whereby women internalise cultural imperatives about what constitutes the ‘good’ women/wife/mother. In their efforts to live up to these impossible cultural images women internalise anger and learn to ‘self-silence’ in relationships in order to preserve harmony, security, and intimacy. Jack describes how this silencing of anger is intimately connected to women's experiences of depression. Mauthner (1998) also identifies self-silencing as an important theme in women's accounts of depression following childbirth. Normative prescriptions of the ‘good’ mother/woman - defined as selfless and selfsacrificing, calm, and capable in the face of motherhood - are intimately tied up with a women's sense of moral worth. Mauthner suggests that the women she spoke with struggled with letting go of these normative prescriptions, holding onto rigid ideas about the ‘right’ way to mother, even while acknowledging that this was harmful to their well-being. Other scholars working within a social constructionist framework explore how individuals negotiate and construct their experiences of depression, drawing attention to the socially constructed diagnostic category of depression (Lewis, 1995; Nicolson, 1991). Other researchers operating within a social constructionist framework highlight the importance of attending to both discursive and material aspects of experience in understanding women's depressive experiences (LaFrance, 2009; Stoppard, 2000; Ussher, 2010). Yardley (1996) highlights the utility of adopting a material-discursive approach to exploring illness experiences that shifts beyond Westernised mind-body dichotomies. She points to the multi-layered and continuous reciprocity between all domains of experience – the material and the discursive domains are in constant and reciprocal interaction - insistence of one domain’s primacy over another, risks obscuring the intrinsically social and embodied aspects of human existence. From this perspective, the embodied and subjective experience of depression are considered to be “ grounded in and to immediately feed back into the ‘lived reality’ of the activities and social context that constitute everyday life” (Stoppard, 1998, p. 89). A material-discursive approach allows acknowledgement of the reality of women's pain and suffering, whilst recognising that understandings of these are discursively constructed and inseparable from their social, historical, and political context (LaFrance, 2009). A key assumption of this approach lies in.

(17) 10. making explicit the socially constructed nature of concepts such as depression, gender, women's lives, and women's bodies. Furthermore, Stoppard (2000) highlights the importance of acknowledging not only the discursive construction of subjective experience, but also the importance of acknowledging the material body as an organism immersed in culture. Much of Stoppard’s work has focused on Westernised discursive constructions of the ‘good’ woman and its implications for women's well being. She explores how women's lives are shaped and regulated by discourses of femininity –a set of shared cultural beliefs about what it means to be a ‘good’ woman. Moreover, discourses of femininity are enacted through practices of femininity, which refers to the activities that constitute women's daily lives. Women's bodies are the primary means through which women engage in these practices and Stoppard (2000) posits that women's depressive experiences are one possible outcome of lives lived at the intersection of these discursive constructions of the ‘good’ woman and the practices of femininity. LaFrance (2009) takes a critical realist approach to women's depressive experiences acknowledging both the material and discursive aspects of existence. This perspective acknowledges the existence of the material world - and this includes not only the properties of the physical body, but also the properties and organisation of the physical and social environment (Burr, 2003). At the same time, this perspective views our knowledge of the world as always socially constructed. LaFrance draws on ideas from Willig (1999) and Parker (1992) that highlight how these material structures afford the possibility of certain constructions more readily than they do others. With this in mind, LaFrance takes a discourse analytic approach drawing on both top-down and bottom-up approaches to exploring discursive resources and practices in her research on how women construct their depressive experiences. Her work particularly focuses on how medicalised biochemical constructions of depression position women and their depressive experiences in such a way that the subjective experience of depression is stripped of its social and political context. She suggests that an ongoing adherence to a positivist ontology that rests on assumptions of naturalism and individualism leaves few possibilities for legitimising ones subjective experiences. Furthermore, she explores how the ideological and institutional structures of discourses of femininity and biomedicine work together to both silence and create women’s pain (LaFrance, 2009).

(18) 11. The Research Focus Drawing on findings from these authors that highlight the importance of exploring material and discursive aspects of women's depressive experiences, the present study aims to add to this small but important body of knowledge about women's depression. Despite the consistency of findings from feminist and social constructionist scholars, these ways of understandings women's depressive experiences is absent from mainstream theorising about depression. This study seeks to add to this body of discursive research by exploring the subjective experiences of depression and the seeking of professional help for the women who participated in this study. I aim to explore the relationship between the women's subjective experiences and their discursive worlds; to explore, describe, and critique the discursive world the women inhabit and the implications for possible ways-of-being. In order to do so, I draw on aspects of Foucauldian discourse analysis, and Davis and Harre’s positioning theory (Davies & Harré, 1990:Harré & van Lagenhove, 1999; Willig, 2000). In doing so, I hope to offer some new insights into the processes involved in the women's experiences of depression and their sense-making journeys..

(19) 12. Chapter 2: Method Discourse and Subjectivity Before continuing, I wish to make explicit the assumptions on which this study rests. The primary focus of Foucauldian discourse analysis is the role of language in the constitution of social and psychological life. The availability of discursive resources within a particular culture, from a Foucauldian viewpoint, has implications for those who live within it (Willig, 2008). Parker (1994) defines discourses as “sets of statements that construct objects and an array of subject positions” (p. 245). These constructions afford individuals certain ways of seeing-the-world and being-in-the world (Willig, 2008). Given these assumptions, Foucauldian discourse analysis explores the role of discourse in the constitution of subjectivity, selfhood, and power relations (Burr, 2003; Willig, 2000). While much of the work by discourse analysts involves the examination of expert discourse and theorizes possible implications for subjectivity from this work, I have chosen to approach this from a different position. This study is concerned with the subjective experiences of the women involved and as such is grounded in the ‘realities of the women's lives – attention to the material and social aspects of the women's stories remain a focus throughout the analysis. Discourses are grounded in social and material structures, such as institutions and their practices (Willig, 2000) and as Parker (1992) reminds us, therefore we need to “...attend to the conditions which make the meaning of texts possible” (p. 28). I begin with the women's accounts of depression and seeking professional help, identifying the prevalent discursive constructions in the women's stories. In order to offer a contextualised understanding of the women's constructions it is important to move between a micro-focus and a macro-focus in order to define and critique the discursive worlds the women inhabit. Positioning theory offers a useful conceptual tool for exploring the subject positions afforded the women from within any particular discourse. Subject positions from this viewpoint, “constitute ways- of-being through placing the subject within a network of meanings and social relations which facilitate as well as constrain what can be thought, said, and done by someone so positioned”( Willig, 2000: 557).. Recruitment Recruitment of participants took place in a provincial centre in the North Island of New Zealand. Given the small number of people required for this study, it was hoped a snowballing effect would be sufficient for recruitment purposes. I initially spoke with two people in my community whom I knew to have had experience with depression and whom I knew would be.

(20) 13. comfortable with my speaking to them about this. I invited them to participate and asked that they extend this invitation to anyone they thought might be interested. I also spoke with a small number of people in my community about the research I was undertaking and asked that they pass this invitation to anyone they thought might be interested in participating. Interested parties had a number of options for initiating contact about participating in this study. Anyone that felt comfortable doing so had the option of contacting me directly via e-mail or telephone. If they preferred they could request an Information Sheet (see Appendix 1) from the person who initially spoke with them about the study. A third option of having their name and number passed to me so that I could initiate contact was also available. At all stages of this initial process it was clearly stated that by contacting me or asking for an information sheet, interested persons were not making any commitment to participate. Seven women requested that I make initial contact with them to speak in more detail about the study – all of these women agreed to participate at this point. On contacting the women, I explained the purpose of the study, and the criteria for participating. I explained that I was interested in hearing their stories of depression and seeking professional help and that I thought it was important to hear women's voices - voices often lost in stories of depression. For the purposes of this study, participants were required to have experience with what they identified as depression at some point in the past 2 years and to have sought professional help during this time-period. Professional help may have involved one appointment or several appointments. Given the possibly sensitive nature of the topic in question, and in order to ensure the safety of anyone who decided to volunteer, it was important those women who had continued involvement with professional help services identified as being past any crisis that may have led them to seek help in the first place. In addition, those women who had continued involvement with mental health services were asked to identify a named person they were comfortable speaking with should any issues arise for them. These ethical and safety issues, critical in the recruitment process, formed a significant part of the Massey University Human Ethics Committee proposal and considerations -see below. Following this initial telephone contact, all of the women volunteered their time. Interview times were set and in the meantime, I arranged to send an Information Sheet to the women and asked them to call me if they had any further questions or if they changed their minds.. Participants Seven women volunteered to participate in the study. They ranged in age from 33-43 years. All of the women were married, although one woman was recently separated. Although this study.

(21) 14. did not set out to specifically recruit mothers of young children, those women that volunteered their time and knowledge were all mothers to pre-school and primary school aged children. Five of the women had two children, one woman had three children, and one woman had four children. Given the method of recruitment, the likelihood of this occurring is not surprising - at the time of undertaking this research, I had one pre-school and one primary school aged child. A significant portion of my time was spent involved in early-childhood settings. The women's economic, social, and personal circumstances varied. Only one of the women was working outside the home at the time their stories of depression took place. All of the women identified as New Zealand European.. Interviews The women requested interviews be conducted in their own homes and suitable times were arranged that were likely to bring a minimum of interruption. Perhaps the most important part of the interview process was establishing rapport before moving onto exploring the topic in question. The feedback from each of the women strongly suggests this was successful and facilitated a safe and meaningful experience for all concerned. One woman told me that she had recommended being involved in this research to a friend because it had been a powerful and empowering experience for her. Six of the seven women told me this had been their first opportunity to tell their story freely and without time limits – and as such, they found it a thought-provoking and positive experience. Prior to starting the interviews, we discussed my role as researcher and student; the women were encouraged to ask any questions. We addressed issues of confidentiality at this point - the likelihood of contact between a number of the participants and me through our mutual involvement in early childhood and school services was an important area of discussion. Given the participants were sharing often painful and private experiences with me it was important to talk about how this might be for them following the interviews and at any later date. Interviews lasted on average between 1½ - 2½ hours. I conducted the interviews in a relatively informal and supportive manner. I began the interviews by asking the women to choose where they would like to start - where it felt comfortable and made sense for them to do so. The women were free to choose how they addressed these issues and to bring forward any topics they felt were relevant to their stories. I specifically wanted to ensure that the women had the opportunity to raise anything they considered important rather than impose any pre-conceived notions of what I thought was important. I used a small number of open-ended questions intended to ensure coverage of three major areas of enquiry - the women's experiences of.

(22) 15. depression; their decision to seek help and their experiences of seeking professional help; and how they made sense of these experiences. Additionally, I sought clarification where needed in hopes of avoiding making assumptions on my part about how the women might have made sense of, or felt about, various aspects of their experiences. All interviews were audio-recorded. I personally transcribed each interview. My intention during the transcribing process was to produce a transcript that was representative of the women's original wording. Some aspects of speech, other than wording, have been included only where they add to ‘hearing’ the voices of the women. Throughout the analysis, I have used pseudonyms for the women's names and have used the initials JB for myself. Italics have been used to present the speech of the women and the interviewer. Any clarifying information has been provided in written form where needed at the end of the relevant excerpt. I have used bold to indicate speech emphasis. Where the women took long pauses I have noted this in words. I have used three periods ... in a row to show that some speech has been left out of an excerpt.I have used square brackets [ ] to indicate that information has been omitted for confidentiality purposes.. Ethical Considerations I sought permission to undertake this research through the Massey University Human Ethics Committee: Northern (MUHECN). Details of the ethical considerations relevant to this study were outlined and addressed in the submitted proposal. The primary focus of such considerations was the safety and confidentiality of those involved. Given the sensitive nature of the topic in question, the potential for possible distress during and after interviews was a primary concern. My previous experience working with vulnerable groups and an ongoing commitment to reflective practice provided me with the experience to conduct interviews in an ethical manner that reflects an awareness of power and vulnerability issues. These issues were further addressed with each participant, (see Recruitment, and Participant section) and detailed in the Information Sheet (Appendix 1). Information pertaining to confidentiality, including treatment of audiotapes and transcripts, was included in the Information Sheet. The Consent forms (Appendix 2) specifically related back to the Information Sheet and provided the option for feedback if the women choose. Ethical permission was approved without additions or changes (No: MUHECN 10/010)..

(23) 16. Analytic Process Analysis began with repeated listening to the audio tapes. The aim was to create a sense of feltcontext, to familiarise myself with the stories as they were narrated. This heard context, removed when I began working with the transcribed materials, proved valuable as I immersed myself in repeated and thorough readings of each transcript, taking note of the overall structure of each story. It was quickly clear that the women narrated stories that were remarkably similar in structure and it this structure that informs the presentation of the findings in Chapters 3-5. (I return to this shortly). Repeated readings of the narratives provided a framework for exploring the discursive resources used in the construction of each woman’s story of depression. I began by examining all references to various aspects of distress, sadness, and depression and then located each of these within its surrounding context. This enabled me to identify the different ways the women constructed depression or associated experiences as they moved through an unfolding story of becoming depressed and seeking professional help. This was important given the women changed the way they constructed their depressive experiences as they moved through their narratives. I identified prevalent discursive construction of distress throughout each narrative, and then identified prevalent discourses surrounding these constructions. In doing so, I was constantly contextualising what the women were telling me. For example, during the reconstruction of the women's experiences of ‘becoming depressed’, the women spoke of their inability to cope as arising from an individual flaw. In order to explore how they had come to this conclusion it was important to look at the discourses surrounding this notion and to examine how these might support this idea. Equally important was attention to what may be missing from the surrounding conditions that constrained the women arriving at a different conclusion. I was conscious that in examining a particular section of text away from the surrounding text, there is a risk of losing the context of the construction in question. It is possible to lose some of the context for exploring, “why this way?” Having identified the various ways the women constructed distress and depression, and the meaning these experiences held for them, I examined how these changed over the course of their story. In the early part of the narratives the women drew on contextual explanations for their distress, as they moved through their stories, these explanations shifted to internalised constructions where the women saw themselves as ‘bad’ mothers - further into their stories these explanations shifted to accommodate biomedical explanations..

(24) 17. I then shifted my focus to explore the broader socio-cultural context. I immersed myself in the depression literature. I examined and critiqued various constructions of depression available in society and explored the subject positions that may be available within each of these. I explored existing literature that explored these topics to see which of these, if any, helped to make sense of the data provided by the women. I read and read and read. Some of what I read while certainly interesting and possibly relevant, was not relevant to the data that I was working with, and so I either put this aside or where appropriate, suggested its possible relevance within the discussion. Other readings proved more fruitful and allowed me to build a ‘contextual map’. I continually moved between the literature and the data. The questions running through my mind as I did this revolved around issues such as, “how do you construct your story of depression, why have you drawn on this discursive resource and not another, what subject positions does this make available to you, how does this constrain or enable certain actions, thoughts, ways-ofbeing?” The relationship between discursive resources and practices, the positions they offered, and the women's subjective experience was at the forefront of all these questions. Throughout this process, when identifying discourses reflected in the women's talk, it was important to take an historical exploration of the discourses that surrounded and supported these primary ones. In doing so, the question becomes more focused on institutional power and practices – “Why is this discourse more readily available than another – what supports this – what broader discourse might this be part of?” Another set of questions I employed as I moved between the literature and the data, focused on, “What constrains the women from taking up positions available within different discourses – what happens when they do?” As I moved back and forth between the literature and the data, I merged the findings regarding what is happening at the micro level – the women's stories - with the broader stories in the cultural context they inhabit –macro-level. The importance of merging these two together to provide a contextualised account drives the decision to present the findings and discussion together. Through this process of merging, the women's stories made more and more sense, the trajectories they moved along were apparent, and they were located quite clearly within a cultural context that more easily afforded certain ways-of-being and not others. The final analysis offered a way of seeing the unfolding processes, the depression trajectories of the women – whereby, given this particular context, drawing on these particular discourses, offering these subject positions, the relationship between the women's discursive worlds and their subjective experiences of depression became highly visible. While another person may produce an entirely different reading of the women's transcripts, I leave it to the reader to decide if, given the explicit assumptions I have outlined, the following story – The Findings –represents a.

(25) 18. plausible, useful, and meaningful account of the depression trajectories of the women who participated in this study.. Presentation of the Findings The women all began their stories with a contextualised account of the conditions leading up to ‘becoming depressed’ - they spoke of their decision to seek help and their experiences of seeking help – and they spoke of life after diagnosis. Given the clear structure of each of the women's stories, I have presented ‘The Findings’ following these lines: Chapter 3 -Becoming Depressed; Chapter 4 – Entering the Professional Help Arena; Chapter 5 – The Aftermath Section 1 – Medicated Living, Section 2 – Living With Complexity, Continuing Invisibilities. Excerpts used throughout the Findings Chapters reflect the speech used in the original narratives and wording has not been adjusted to provide ease of reading. I have not included a number of aspects of speech acts such as utterances, inflections, except where this is important for providing information – such as long pauses or the use of notable emphasis. All participants were assigned a pseudonym. I have made every effort to use speech excerpts from all the women in similar quantities..

(26) 19. Chapter 3: Findings and Discussion Becoming Depressed When I asked the women if they could tell me about their experiences of depression and how they managed to make sense of what was happening to them, I suggested they started wherever it made sense to them to do so. It was clear the women had no difficulty finding a starting point, a space where ‘it’ began - where things started to go wrong. Their experience of depression had not occurred within a vacuum; the stories were located within a time and place, a contextual setting. That the larger part of the women’s narratives, was made up of this contextual explanation suggested its importance to the women. Not only did the attention paid to reconstructing this part of the story indicate the importance of context to them, it suggested they felt it was important I understand that in fact there had been a context. They drew on social, relational, and material aspects of their lives to position themselves within the locale where their experiences of depression had occurred, and in doing so told stories that were rich in detail, varied and ultimately complex. While it is not the intention of this analysis to explore in detail the content of each woman’s story, I do wish to illustrate this contextual complexity by providing a brief outline of some of the most important social, relational, and material aspects of one woman’s life that she brought forward when talking about her experiences of depression. Kate told of how she had cared for her deeply depressed mother following her parent’s divorce. She looked after her mother essentially on her own from age 21 -24, until her mother finally took her own life. She talked of the shame of divorce at that time and how she felt watching her strong, vibrant mother become a shell. She went onto tell of her upcoming marriage, her impending role as stepmother to two children and the unfairness of being cast as the ‘other woman’, the ‘evil stepmother’. She spoke of mixed feelings regarding her changing identity from individual, to wife and stepmother, of the loss of freedom and increased responsibility. She spoke about the exhaustion and anxiety she felt as she managed her own business while also managing a newly formed household. She was uncertain about her fiancé’s commitment to this new venture and felt she was putting in far more effort to accommodate his children and their needs. She was angry and tired, and was having difficulty sleeping. And, if that wasn’t enough, she talked about the trauma of finding a friend who had successfully suicided. She finished this scene setting by concluding that, ‘I guess that’s some quite big stuff’. The content of this story is unique to Kate and as we would expect the content of each women’s narrative is uniquely her own. However, what this summary so clearly illustrates is the level of contextual complexity that makes up the conditions of this woman’s life. Her story highlights numerous.

(27) 20. elements or strands interacting and feeding back. There is fluidity to how each strand moves and weaves with the other strands; none of them simply existing in isolation; to try to understand them as such leaves one with an incomplete picture. When we look at the elements highlighted in another woman’s story, it is possible to see this contextual complexity illustrated again. When Susan’s story began, she had recently stopped working and was at home caring fulltime for her three children. She has one older child and has recently had twins. There has been a significant change in the family’s financial situation since she stopped paid work and her day-to-day activities have changed dramatically. She is married but describes her husband as uninvolved in the care of the children. She feels she has no support from him with regard to any issues related to looking after their three children. In fact, she feels he resents her for not being more available to meet his needs. She feels resentful of his demands whilst also feeling guilty if she does not meet them. She says he often treats her in a manner that leaves her feeling frustrated, unattractive, and alone. Their marriage is on rocky ground and they do separate part way through this story. She describes the rising exhaustion she feels as she cares for her children essentially on her own, and the relentless demands of breastfeeding and night feeds. She has little time with twins for doing anything other than looking after them and keeping the house clean and food on the table. She also talks of the high expectations she places on herself to be a good wife and mother and how trying to fulfil these expectations leaves her utterly depleted of energy. At the same time, she feels guilty about all the things she cannot do and all the things she does not do well, including attending to the needs of her eldest child who experiencing problems at school. She talks of the conflict that arises between her mother who offers support and her husband who resents this support; how she feels caught in the middle and eventually finds herself forced to ask her mother to stop coming to their house in order to avoid the conflict this creates with her husband. She tells me how telling her mother -and her only source of practical support –not to visit anymore, leaves her saddened, angry, and alone. Susan talks about her upbringing; she believes this plays a part in her unwillingness to confront her husband. She talks of her father having bi-polar affective disorder and of the daily arguing and yelling she witnessed as she was growing up. An overwhelming desire for peace and quiet was the result; and this avoidance of conflict was instrumental in her choosing to swallow her anger with her husband. She knew there was a cost but still felt compelled to pay this price because at the same time, she felt a great need to protect her children from seeing their parents argue. She talks in some detail about growing up in her family with a parent who is mentally unwell. She also talks at length about a relationship with her mother that is supportive, and at the same time, a source of shame in relation to her perception of herself as weak for not coping as well as she thinks she should. Throughout her narrative, an overarching.

(28) 21. theme is the exhaustion, the constant and relentless tiredness she experiences and the inability to find space or time to revitalise any reservoirs of energy she may have. Susan tells of reaching a point where she just ran out of energy – she says, “I just had enough, I couldn’t do it anymore”. While we see a story here that is quite different in content from the previous story, what is remarkably similar is the contextual complexity contained within each narrative. The strands do not stand alone. Both women’s stories whilst unique in content are not unique in this complexity; complexity is inherent in all the women’s stories. The women made it clear to me there was a context to their stories and to understand what had happened, I needed to understand the context in which their experiences were located. The women's stories were, in varying degrees, filled with accounts of trauma and violence, loneliness, childhood bullying, family and relationship troubles, physical health problems and, for some, poverty. The women talked about aspects of their lives they considered may have played a role in the stories of depression, and as one would expect, each of the women highlighted aspects particular to her life, as being more or less important in these experiences. However, it was also clear the stories they told were ones embedded in their lives as women; they were gendered stories. They spoke of aspects of their lives intimately tied up with their identities as mothers, as daughters, and as wives. These stories were filled with the demands the women faced as they managed relationships, provided childcare, ran households, provided care and love for those around them, worried about finances, struggled with health problems, and struggled with lack of sleep and lack of time. Alongside these demands, the women also spoke of isolation, loneliness, frustration, ambivalence, and in the negotiation of such complexity the women spoke of the unceasing demands upon their physical/material bodies; demands that left them depleted, anxious, and exhausted. They described their struggles to manage this complexity, to keep moving forward without complaint or without showing signs of this struggle, and central to all of these aspects of experience, was their ongoing struggle to live up to their notions of what it meant to be a ‘good enough’ mother, daughter, and wife. What is interesting in these reconstructions, is that as much as each of the women brought forward this contextual complexity, their stories hold a powerful tension; context is important, it is within this context their experiences of distress take place, and yet, they do not perceive these contextual conditions as sufficient to legitimise that distress. As we move through their stories, we see the importance of this tension-filled discordant relationship between the contextual complexity of their lives, and their perception that these same conditions are insufficient to account for the level of distress they feel. It is the production of this tension, and the.

(29) 22. implications for the women as they find themselves caught at the centre of such tension, which is of interest in the remainder of this chapter. A gendered phenomenon. When beginning this stage of the analysis around women's accounts of depression, and delving into the vast amount of literature that has been generated by researchers in their attempts to predict and explain depression, I was struck by the comparatively small number of studies that began their analysis from the individuals own account of becoming depressed. Equally striking amongst this small amount of research that does begin with individual accounts, was the consistency of findings that strongly supports the assertion by social constructionist and feminist writers that depression is a gendered phenomenon (Galasinski, 2008; Jack, 1991; LaFrance, 2009; Maracek, 2006; Stoppard, 1998, 2000; Stoppard and McMullen, 2003, Ussher, 1991). This assertion by social constructionist and feminist writers that depression is a gendered phenomenon is not new and presupposes that gender encompasses more than an individual’s biological sex assignment. Typically, research into depression has treated gender as a characteristic of the bounded individual where, as Stoppard (2000) describes, the boundaries of the individual start and finish with the surface skin of the physical body and gender is defined as the person’s sex assignment, that is, either female or male. However, when gender and the individual are conceptualised and operationalised in this way, fundamental aspects of their experience are excluded from consideration and therefore from our understandings of depression. Stoppard (2000) points out that when aspects of gender such as the division of labour in society are ignored or taken-for-granted, and symbolic aspects of gender within the discursive domain are excluded from consideration in depression research, the socio-political and cultural context of people’s lives is rendered invisible (p18). Consistent with this, the women's narratives strongly suggested that it is here, embedded within this sociocultural arena, and bound up with central elements of symbolic gender such as the widely shared and often implicit assumptions about femininity that their suffering is located. In line with studies that take women as their starting point (LaFrance, 2009; Stoppard, 2000), I suggest that for the women in this study, it is at the intersection of what these social constructionist writers term ‘discourses of femininity’ and ‘practices of femininity’ that their suffering is located. Stoppard (2000) uses the term ‘discourses of femininity’ to denote “the set of discursive resources that have women as their focus” (p. 209). In Western society, cultural discourses of femininity often portray women as inherently caring, nurturing, emotional, empathetic, selfsacrificing, and other-oriented (Bamberg & Andrews, 2004; Burr, 2003; LaFrance, 2007, 2009; Miller, 2005; Stoppard, 1998, 2000). These discourses operate through the largely unconscious or taken-for-granted assumptions shared by people living within the same socio-cultural context.

(30) 23. (Stoppard, 2000) and far from being simply abstract ideas, are intimately connected with institutional and social practices (Burr 2003). As such, they have powerful implications for the way we can and do live our lives. As Burr (2003) says, it is only a short step from these assumptions, to construct women as the most natural carers of children and other family members, and most suited to the tasks of running domestic households, and thus discourses of femininity dovetail with structures and practices in society that support the gendered division of labour. Embedded within these broader discourses of femininity are powerful imperatives about mothering and family life that position women as responsible for the smooth running of domestic life, regardless of employment outside the home, and as ultimately responsible for the lifelong welfare of their children who require selfless, intensive nurturing (Miller 2005; Stoppard, 2000). The idea of ‘good’ mothering, and the ‘good’ woman generated from within these discourses, carry alongside them the possibility of the ‘bad’ mother, the ‘bad’ woman. It is perhaps no coincidence, that during the course of her story, each of the women in this study embarked upon, and was immersed within, a story of mothering pre-school children and it is within this locale the women's stories take place. The women's stories in this analysis centre on their day-to-day activities, those regulated and shaped by discourses of femininity - taken-forgranted and often devalued -performed by the finite resources of the material body. It is here at this intersection between discourses and practices of femininity that their stories of depression unfold. I chose to focus on these two aspects of experience in relation to family life and mothering in large part because of the dominance of their presence throughout the women's narratives, and certainly, because of how they are implicated in the subjective and embodied experience of suffering for these women. In addition, however, I was also struck by the consistency of findings from research that begin with women's accounts showing these elements as important in women's depressive experiences (LaFrance, 2009; Stoppard, 1997, 1998, 2000). Yet these day-to-day aspects of women's lives are largely absent in theorising about depression and women's distress in Western society. It is important to be clear, however, that by looking at these particular aspects of the women's experience I am not suggesting they can, or should be, separated from other aspects of the women’s stories. They intertwine with the women’s subjective history, and their individual material and discursive worlds. They are however, referred to consistently by the women as critical elements in their story of depression, and have an implicit and interesting relationship with their decisions to, and experience of, seeking help..

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